Background: As Posttraumatic stress disorder (PTSD) in adolescents significantly impacts their well-being, effective treatment is of great importance. Little is known, however, about the novel,... Show moreBackground: As Posttraumatic stress disorder (PTSD) in adolescents significantly impacts their well-being, effective treatment is of great importance. Little is known, however, about the novel, multi-modal virtual reality supported, exposure-based psychotherapeutic interventions such as 3MDR in this population.Objective: To describe the 3MDR treatment of an adolescent with PTSD who did not respond to previous exposure-based PTSD interventions.Method: A 14-year-old girl diagnosed with PTSD received six sessions of 3MDR embedded in family therapy.Result: The patient tolerated the 3MDR intervention very well. Personalized music and self-selected pictures appeared to be a good fit, contributing to enhanced engagement in and adherence to the therapy. She no longer met criteria for PTSD post-intervention, and at 18 months follow-up.Conclusion: This case report suggests that 3MDR has potential as a trauma treatment for adolescents with treatment-resistant PTSD. Show less
Lay Summary Mental health problems among children and youths are common and have impacts, not only on the person affected but also on families and communities. They are often not recognized and... Show moreLay Summary Mental health problems among children and youths are common and have impacts, not only on the person affected but also on families and communities. They are often not recognized and acted upon by primary care providers (PCPs), such as general practitioners. This may be due to a lack of confidence in talking to young people or insufficient knowledge about mental health problems. PCPs make decisions about managing or referring these problems to mental health specialists, which can be assisted through clinical decision support methods (CDSMs). CDSMs can be divided into electronic and non-electronic. This study provided an overview of both types of CDSMs. We focused on the capabilities of CDSMs and how they help PCPs in their decision-making. More than half of the reviewed CDSMs were electronic CDSMs; several CDSMs involved telecommunication between PCPs and mental health specialists. Two of the CDSMs comprised a combination of components of both types of CDSMs. CDSMs offered patients more information about their health while providing PCPs with suggestions for their decision-making.Background Mental health disorders among children and youths are common and often have negative consequences for children, youths, and families if unrecognized and untreated. With the goal of early recognition, primary care physicians (PCPs) play a significant role in the detection and referral of mental disorders. However, PCPs report several barriers related to confidence, knowledge, and interdisciplinary collaboration. Therefore, initiatives have been taken to assist PCPs in their clinical decision-making through clinical decision support methods (CDSMs). Objectives This review aimed to identify CDSMs in the literature and describe their functionalities and quality. Methods In this review, a search strategy was performed to access all available studies in PubMed, PsychINFO, Embase, Web of Science, and COCHRANE using keywords. Studies that involved CDSMs for PCP clinical decision-making regarding psychosocial or psychiatric problems among children and youths (0-24 years old) were included. The search was conducted according to PRISMA-Protocols. Results Of 1,294 studies identified, 25 were eligible for inclusion and varied in quality. Eighteen CDSMs were described. Fourteen studies described computer-based methods with decision support, focusing on self-help, probable diagnosis, and treatment suggestions. Nine studies described telecommunication methods, which offered support through interdisciplinary (video) calls. Two studies described CDSMs with a combination of components related to the two CDSM categories. Conclusion Easy-to-use CDSMs of good quality are valuable for advising PCPs on the detection and referral of children and youths with mental health disorders. However, valid multicentre research on a combination of computer-based methods and telecommunication is still needed. Show less
Nielsen, P.; Christensen, M.; Henderson, C.; Liddle, H.A.; Croquette-Krokar, M.; Favez, N.; Rigter, H. 2021
Background and aims: Social variables including parental and family factors may serve as risk factors for Internet Gaming Disorder (IGD) in adolescents. An IGD treatment programme should address... Show moreBackground and aims: Social variables including parental and family factors may serve as risk factors for Internet Gaming Disorder (IGD) in adolescents. An IGD treatment programme should address these factors. We assessed two family therapies multidimensional family therapy (MDFT) and family therapy as usual (FTAU) - on their impact on the prevalence of IGD and IGD symptoms. Methods: Eligible for this randomised controlled trial comparing MDFT (N = 12) with FrAu (N = 30) were adolescents of 12-19 years old meeting at least 5 of the 9 DSM-5 IGD criteria and with at least one parent willing to participate in the study. The youths were recruited from the Centre Phenix-Mail, which offers outpatient adolescent addiction care in Geneva. Assessments occurred at baseline and 6 and 12 months. Results: Both family therapies decreased the prevalence of IGD across the one-year period. Both therapies also lowered the number of IGD criteria met, with MDFT outperforming FTAU. There was no effect on the amount of time spent on gaming. At baseline, parents judged their child's gaming problems to be important whereas the adolescents thought these problems were minimal. This discrepancy in judgment diminished across the study period as parents became milder in rating problem severity. MDFT better retained families in treatment than FTAU. Discussion and Conclusions: Family therapy, especially MDFT, was effective in treating adolescent IGD. Improvements in family relationships may contribute to the treatment success. Our findings are promising but need to be replicated in larger study. Show less
Dorp, M. van; Boon, A.; Spijkerman, R.; L. los 2020
Issues Migrant adolescents show specific risk and protective factors associated with substance use, but the extent to which prevalence rates differ between migrant and native-born youth in Europe... Show moreIssues Migrant adolescents show specific risk and protective factors associated with substance use, but the extent to which prevalence rates differ between migrant and native-born youth in Europe remains unclear. The present study aims to provide a comprehensive review of all available substance use prevalence studies on differences in substance use between migrant and native-born adolescents in Europe. Approach In this systematic review, PubMed, Medline and Pre-Medline, EMBASE and PsycINFO were searched for articles comparing substance use prevalence rates (tobacco, alcohol, illicit drugs) between migrant and native-born adolescents or young adults aged 11 to 29 years in European countries. The Joanna Briggs Institute prevalence critical appraisal tool was used for quality assessment. Key Findings Fifteen studies met the inclusion criteria. The findings unanimously showed lower alcohol use in migrant compared to native-born adolescents, in particular among migrant adolescents from non-European countries and/or with a Muslim background. For tobacco and illicit drug use, findings were mixed. Implications The results suggest a healthier behaviour profile among migrants than among native-born adolescents regarding alcohol use. Therefore, it would be beneficial to develop interventions to support migrant communities in maintaining their healthier alcohol use practices upon arrival in the host country. Conclusion Compared to native-born adolescents, migrant adolescents are less likely to use alcohol. The findings on tobacco and illicit drug use were mixed. A European standard for surveys regarding substance use among adolescents is needed to investigate fluctuations, causes, and consequences of substance use differences between migrants and natives at the European level. Show less
Aim Risperidone is the most commonly prescribed antipsychotic drug to children and adolescents worldwide, but it is associated with serious side effects, including weight gain. This study assessed... Show moreAim Risperidone is the most commonly prescribed antipsychotic drug to children and adolescents worldwide, but it is associated with serious side effects, including weight gain. This study assessed the relationship of risperidone and 9-hydroxyrisperidone trough concentrations, maximum concentrations and 24-hour area under the curves (AUCs) with body mass index (BMI)z-scores in children and adolescents with autism spectrum disorder (ASD) and behavioural problems. Secondary outcomes were metabolic, endocrine, extrapyramidal and cardiac side effects and effectiveness. Methods Forty-two children and adolescents (32 males) aged 6-18 years were included in a 24-week prospective observational trial. Drug plasma concentrations, side effects and effectiveness were measured at several time points during follow-up. Relevant pharmacokinetic covariates, including medication adherence andCYP2D6,CYP3A4,CYP3A5and P-glycoprotein (ABCB1) genotypes, were measured. Nonlinear mixed-effects modelling (NONMEM (R)) was used for a population pharmacokinetic analysis with 205 risperidone and 205 9-hydroxyrisperidone concentrations. Subsequently, model-based trough concentrations, maximum concentrations and 24-hour AUCs were analysed to predict outcomes using generalized and linear mixed-effects models. Results A risperidone two-compartment model combined with a 9-hydroxyrisperidone one-compartment model best described the measured concentrations. Of all the pharmacokinetic parameters, higher risperidone sum trough concentrations best predicted higher BMIz-scores during follow-up (P< .001). Higher sum trough concentrations also predicted more sedation (P< .05), higher prolactin levels (P< .001) and more effectiveness measured with Aberrant Behavior Checklist irritability score (P< .01). Conclusion Our results indicate a therapeutic window exists, which suggests that therapeutic drug monitoring of risperidone might increase safety and effectiveness in children and adolescents with ASD and behavioural problems. Show less
Background: Mitotic rate is a strong predictor of outcome in adult patients with primary cutaneous melanoma, but for children and adolescent patients this is unknown.Objective: We sought to assess... Show moreBackground: Mitotic rate is a strong predictor of outcome in adult patients with primary cutaneous melanoma, but for children and adolescent patients this is unknown.Objective: We sought to assess the prognostic value of primary tumor mitotic rate in children and adolescents with primary melanoma.Methods: This was a cohort study of 156 patients who were <20 years of age and who had clinically localized cutaneous melanoma. Patients <12 years of age were classified as children and those 12 to 19 years of age as adolescents. Clinicopathologic and outcome data were collected. Recurrence-free and melanoma-specific survival were calculated. Univariable and multivariable analyses were performed using Cox proportional hazard models.Results: Thirteen of 156 patients (8%) were children. The mitotic rate was >= 1/mm(2) in 104 patients (67%) and correlated with increasing Breslow thickness. A positive sentinel node was found in 23 of 61 patients (38%) in whom a sentinel lymph node biopsy specimen was obtained. The median follow-up was 61 months. Five-year melanoma-specific and recurrence-free survival rates were 91% and 84%, respectively. Mitotic rate was a stronger predictor of outcome than tumor thickness and was the only factor independently associated with recurrence-free survival.Limitations: This research was conducted at a single institution and the sample size was small.Conclusion: Mitotic rate is an independent predictor of recurrence-free survival in children and adolescents with clinically localized melanoma. Show less
Kar, A.L. van de; Koolbergen, D.R.; Avendonk, J.P.H. van; Horst, C.M.A.M. van der 2019
Objectives: The aim of this retrospective study was to compare subcuticular sutures and Steri-Strip (TM) S in closing median sternotomy incisions in children with regard to wound healing and scar... Show moreObjectives: The aim of this retrospective study was to compare subcuticular sutures and Steri-Strip (TM) S in closing median sternotomy incisions in children with regard to wound healing and scar formation. Methods: Fifty-three children and adolescents were enrolled in this study who all underwent a median sternotomy at age 0-18 years and had their presternal cutaneous wounds closed with either a running subcuticular suture (Group 1) or Steri-Strip (TM) S (Group 2). Their scars were assessed using the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcome measures were the scar measurements and the incidence of wound problems post-surgery. Results: A significant difference was found between both groups in median POSAS observer scale scores for the items thickness (p = .027), pliability (p = .045), surface area (p = .045) and the total score (p = .048). All in favor of the subcuticular suture group. There were no significant differences concerning the POSAS patient scale scores. Middle parts of scars of patients in Group 2 were significantly broader (p = .001) than scars of patients in Group 1. No significant differences concerning wound problems were found. Conclusions: There are, according to our results, no significant differences in wound healing of median sternotomy incisions in children closed with either a subcuticular suture or Steri-Strip (TM) S. Significant differences do exist regarding scar formation and final cosmetic results of the scars, in favor of subcuticular closure. Show less
